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� � <br /> H <br /> C � - <br /> 9Hi��n <br /> Hx � <br /> FC o <br /> "��� -�� � .. <br /> y� � Date � `• P�e���wo��,�a,m��. — <br /> z niap oeoi •��3 YS.7% <br /> �� � Applicalion For _ <br /> �M(� �y-y PUBLIC WORKS PERMIT �°°'"`"°'""`� <br /> H TotalFev $ — — <br /> !'1 � LJ Less FpPI Fee Pa�d 5 — <br /> �Y (] <br /> � y� e.,i��«o�� S <br /> Print or Type Only <br /> HH <br /> gb y • Ss/�? _ ,?•� �dtie tJ e-vr 5'S zc�3 3�/�- 3 S.S 2 <br /> CC �E�� /� ��E� C�T /r� MaiHng Address City Zip Phone <br /> ��z� � Owner <br /> Hoc�i� ci 3 � / � �N..� 5SG?Y" ��/-v �: <br /> App�icant Mailing Address City Zip Phone <br /> Describe Proposed Work �•-'G�✓ , � � ��"� � `rF'�� --- <br /> _ W <br /> Project Address lit known� �ia- �3�-`°.A-�E��_ � <br /> Attach lour(4)copies ol plans for proposed work- Draw to scale and note ihe following as applicable: � <br /> • Property Lines • Genlerline ol sireet � <br /> • OuUine and dimensior.s of all eaistiny antl • Indicate Norih <br /> proposed struclures on�he lot • Show any proposed c�ratling changes - <br /> '�' • Ezisling and prOpoSed u�ililies • SYow measurements M <br /> � ' DO NOT WRITE BELOW THIS LINE W <br /> �1 O <br /> PERMITCONDITIONS � <br /> '�O ?.All calls for inspection shall be made 24 Y.s.in advance-Phone 259•8810. <br /> 2.All work shall be pedormed in accordance with this permit and curreM City ot Everett Design and Construction <br /> ' ' Standards and Specificalions. � <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> ' l vG l l_-o � S�F-�A-l_L_ �-�l�l -T� O <br /> ��� ��-- ,a.i�l l TP.'2-�� S �lti ��- (. V♦ <br /> �� <br /> �� No t�r`3�� �- t�loe�s 4��t�iT �=�.vi� Q <br /> - a►_ �.�-��--�- <br /> _� s-�- � <br /> 1� ACKNOWLEDGEMENT OF CONDITIONS <br /> �_ _. . The undersiyned owner/applicani hereUy agrees to hold and save harm� <br /> less the City ol Everetl Irom any and all claims lor damages. cosls. <br /> ezpenses, or causes of action lhat may arise because of instailation <br /> and mainten2nce ol the improvement or other right-ol�way use hereto <br /> applied for and Wrther a�rees to remove same upon notice irom ihe <br /> Approvetl for Conslr�ction Date City and to replace public property damagetl thereby. <br /> FINAL INSPECTION Date -- Date <br /> Approved as Cons�ruded Si9nawre ol Appiicmt <br /> WORK AUTHCRIZED BY THIS PERMIT MUST BE ST�RTED W�TI-IIN <br /> neverett PUBLICWORKSDEPAR7MENT 180 DAYS Of DA7E PERMIT IS ISSUED AND THFREAFTER IS TO <br /> 3200Cedar5l ee� BE DIIIGENTLY PURSUED TO COMPLETIGPI.THIS PERMIT MAY BH <br /> UEverett.WA9[201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />